Clostridium difficile isolation in children hospitalized with diarrhoea

IntroductionClostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhoea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonisation in this setting.Materials and methodsA one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhoea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhoea. Risk factors for CDI were identified by multivariate analysis.ResultsTwo hundred and fifty children with acute diarrhoea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n = 31; adenovirus n = 3). The estimated incidence of CDI was 3 cases/1000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhoea, CDI was associated with comorbidity (P < .0001), recent contact with the health-care system (P < .0001) or intensive care unit stay (P = .003) and exposure to antibiotics in the previous month (P < .0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84–232.32; P < .0001).ConclusionsThe isolation of Clostridium difficile is common in hospitalized children with diarrhoea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in paediatrics, especially the percentage of asymptomatic carriers.

ResumenIntroducciónClostridium difficile es la principal causa de diarrea nosocomial en adultos, y su incidencia está aumentado en los últimos años. Es difícil determinar su impacto en niños debido a las altas tasas de colonización.Material y métodosEstudio retrospectivo en menores de 15 años ingresados con diarrea a lo largo de un año. Se estudiaron las características epidemiológicas, clínicas, analíticas y la evolución de los niños con infección por Clostridium difficile (ICD) en comparación con otros aislamientos. Los factores predictores de ICD fueron determinados mediante análisis multivariante.ResultadosSe identificaron 250 niños con diarrea, realizándose estudio microbiológico completo en 174. En 79 (45,4%) se llegó al diagnóstico: 25,6% ICD (n = 19; 13 enterotoxigénicos); 28,6% otras bacterias (n = 21) y 45,8% virus (n = 34; rotavirus n = 31; adenovirus n = 3). Un 68,4% fueron menores de 2 años, y un 15,8% fueron adquiridos en la comunidad. En comparación con otras causas de diarrea, la ICD se asoció a comorbilidad (p < 0,0001), contacto reciente con el sistema sanitario (p < 0,0001), estancia en UCI (p = 0,003) y exposición reciente a antibióticos (p < 0,0001). Los pacientes con ICD cursaron de forma oligosintomática. No hubo diferencias clínicas entre las ICD productoras o no de toxina, siendo la comorbilidad el principal asociado con la ICD (OR 40,02; IC 95% 6,84–232,32; p < 0,0001).ConclusionesEl aislamiento de Clostridium difficile es frecuente en niños hospitalizados con diarrea en nuestro medio. La ICD resultó más frecuente en niños pequeños con comorbilidad y contacto reciente con el sistema sanitario, presentado, en su mayoría, un curso clínico oligosintomático. Se necesitan más estudios para conocer la epidemiología de esta infección en niños.